title: The impact of personalized medicine on survival: comparisons of results in metastatic breast, colorectal and non-small-cell lung cancers.
abstract: Breast, colorectal and lung cancers represent the three most incident forms of cancer worldwide. Among these three "big killers", lung cancer is considered the one with the worst prognosis due to its high mortality even in early stages. Due to their more favorable prognosis, breast and colorectal cancers might appear to have benefited from major advances. Most oncologists who are faced with metastatic non-small cell lung cancer (NSCLC) find the reported results very frustrating when compared with those for metastatic breast (MBC) and colorectal cancers (MCRC). The aim of this analysis was to quantify and compare the relative magnitude of overall survival (OS) improvements in the first-line approaches in metastatic NSCLC, MBC and MCRC through the analysis of the main landmark meta-analyses and randomized clinical trials (RCTs) of commercially available drugs. Five items were considered and analyzed for each cancer. Moreover we evaluated the real clinical impact of the results reported by each item on the entire population; for each "big killer" an overall hazard ratio (HR) was estimated: 0.88 (95%(+) CI: 0.72-1.07) for MBC, 0.94 (95%(+) CI: 0.82-1.07) for MCRC, and about 0.80 (95%(+) CI: 0.73-0.90) for advanced NSCLC. We showed that, in the last decades, these three tumors had important and constant OS improvements reached step by step. The relative magnitude of OS improvement seems higher in metastatic NSCLC than MBC and MCRC.
authors.affiliation: Division of Medical Oncology, S.G. Moscati Hospital, Avellino, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Rossi
authors.affiliation: Laboratory of Methodology for Biomedical Research, Oncology Department, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy. Electronic address: valter.torri@marionegri.it.
authors.forename: Valter
authors.initials: V
authors.lastname: Torri
authors.affiliation: Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Marina Chiara
authors.initials: MC
authors.lastname: Garassino
authors.affiliation: Laboratory of Methodology for Biomedical Research, Oncology Department, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Porcu
authors.affiliation: Department of Medical Oncology, National Cancer Research Center Giovanni Paolo II, Bari, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Galetta
mesh_terms: D001943:Breast Neoplasms / Q000188:drug therapy*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy*; D015179:Colorectal Neoplasms / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy*; D015201:Meta-Analysis as Topic; D057285:Precision Medicine / Q000379:methods* / Q000592:standards; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Biologic agents; Breast cancer; Chemotherapy; Colorectal cancer; Maintenance therapy; Meta-analysis; Metastatic disease; Non-small cell lung cancer; Randomized clinical trial